INDCJournal: Why Steroids Matter

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November 16, 2005

Why Steroids Matter

Posted by Bill

Reading Michael Wilbon's column on MLB's new tough disciplinary policy on steroid use, I wondered how many paragraphs it would take for him to toss in the repetitive, vague, intellectually lazy health bugaboos about the evils of steroid use. Turns out it was six:

From the way Fehr and other union executives initially fought testing and then sanctions, you would think that players had nothing to gain from a get-tough policy against steroids, when in fact players had more to gain than anybody else. While there is still so much we don't know about steroids and their long-term effects, no responsible physician or trainer argues steroids are good for players' health.

Physicians don't argue that lots of things are good for one's health. These omissions do not equal "particularly bad for one's health," though Wilbon's subsequent strong assertions do just that:

In fact, most studies, the overwhelming anecdotal evidence, and the testimony from the steroid hearings, offered in fairly frightening detail, spell out the damage steroids can do over time.

Oh really? "Most studies?" Any references for that? "Overwhelming anecdotal evidence?" Surely not a standard around which to base dire, unequivocal health warnings. And given the "fairly frightening detail" supposedly spelled out between "most studies," "anecdotal evidence," and "the testimony from the steroid hearings," does Wilbon assert one or two examples of the ill effects of steroids? No. Why? Because he's parroting lazy dogma.

One would think a union would want to eradicate anything that brings that kind of health risk to its constituents.

Again, what kind of health risk, exactly?

The smarter members of the union are thankful today that their fraternity brothers are going to be much less likely to take steroids because the consequences are so grave.

Grave, how?

This is the exact type of ridiculous scare-mongering that marks the hyperbolic social taboos and media coverage surrounding anabolic substances in sports, a taboo that bleeds into the larger culture and misinforms the public and health care system about the nature and safe and appropriate usages of steroids. A superb article by Dayn Perry in Reason addresses many conventionally repeated health concerns about anabolics:

Anecdotal accounts of harrowing side effects are not hard to find -- everything from "�roid rage" to sketchy rumors of a female East German swimmer forced to undergo a sex change operation because of the irreversible effects of excess testosterone. But there are problems with the research that undergirds many of these claims. The media give the impression that there�s something inevitably Faustian about taking anabolics -- that gains in the present will undoubtedly exact a price in the future. Christopher Caldwell, writing recently in The Wall Street Journal, proclaimed, "Doctors are unanimous that [anabolic steroids] increase the risk of heart disease, and of liver, kidney, prostate and testicular cancer."
This is false. "We know steroids can be used with a reasonable measure of safety," says Charles Yesalis, a Penn State epidemiologist, steroid researcher for more than 25 years, and author of the 1998 book The Steroids Game. "We know this because they�re used in medicine all the time, just not to enhance body image or improve athletic performance." Yesalis notes that steroids were first used for medical purposes in the 1930s, some three decades before the current exacting standards of the Food and Drug Administration (FDA) were in place.

Even so, anabolic steroids or their derivatives are commonly used to treat breast cancer and androgen deficiencies and to promote red blood cell production. They are also used in emerging anti-aging therapies and to treat surgical or cancer patients with damaged muscle tissue.

And this column by Sean Turner offers some broad rebuttals to prevalent "Steroid Hype:"

So-called "experts" are fond of citing incidents of suicide and irrational behavior, and narrow studies of steroid abuse to justify its criminalization � while they omit or fail to study any pre-existing psychological disorders or other environmental factors.

Steroids, like many common subtances (anti-depressants and alcohol come to mind), have potential for dependence and abuse. This does not justify overstating their risk, nor irrationally demonizing any reward.

Additionally, many of the studies mentioned in both the hearing and elsewhere, tend of focus on merely the abuse of a particular type of steroids � ignoring more tempered usage, or consumption of other kinds of substances classified as steroids.

Exactly. A specific example? "Experts" often cite the side effect of liver toxicity associated with steroid use, neglecting to mention that this negative effect is only associated with certain orally administered steroids, many of which are fairly antiquated and cosmetically employed by a certain odd breed of body builder that's aware of the risk, yet insists on cycling a wide variety of different anabolics to maximize perceived effect. From Perry's Reason article:

Caldwell cites one of the most common fears: that anabolics cause liver cancer. There is dubious evidence linking oral anabolics to liver tumors, but athletes rarely take steroids in liquid suspension form. Users almost uniformly opt for the injectable or topical alternatives, which have chemical structures that aren�t noxious to the liver. And as Yesalis observes, even oral steroids aren�t causally linked to cancer; instead, some evidence associates them with benign liver tumors.
More specifically, it�s C-17 alkylated oral steroids that are perhaps detrimental to liver function. But the evidence is equivocal at best. A 1990 computer-assisted study of all existing medical literature found but three cases of steroid-associated liver tumors. Of those three cases, one subject had been taking outrageously large doses of C-17 oral anabolics without cessation for five years, and a second case was more indicative of classic liver malignancy. It�s also C-17 orals, and not other forms of steroids, that are associated with decreased levels of HDL, or "good" cholesterol. But, again, C-17s are almost never used for athletic or cosmetic purposes.

Despite this sketchy causality and the requisite use of specific steroids associated with this ill effect, liver toxicity (and cancer) is one of the most frequently cited unequivocal side effects of "steroid use." The mere possibility ostensibly grants free license for health officials, members of the media and government authorities to demonize an entire class of substances that share a similar muscle-building action, when only certain types of the less commonly used varieties - but not others - have a dubious association with negative side effects.

And what about the dreaded "Roid Rage?"

Another commonly held belief is that steroid use causes aggressive or enraged behavior.
...
"There�s very inconsistent data on whether �roid rage even exists," says Yesalis. "I�m more open to the possibility than I used to be, but its incidence is rare, and the studies that concluded it does exist largely haven�t accounted for underlying factors or the placebo effect."
Scientists are nearly unanimous that excessive testosterone causes aggression in animals, but this association begins to wither as you move up the evolutionary ladder. Diagnosing such behavior in athletes is especially tricky. "There�s a certain degree of aggression that�s not only acceptable but necessary in competitive sports," Yesalis says. "What�s perhaps just the intensity that�s common to many athletes gets perceived as steroid-linked outbursts."

In fact, it's probably important to note that men with low levels of testosterone are perhaps more susceptible to aggression, irritability and other negative psychological traits, whereas high circulating levels of testosterone (or synthetic variants, potentially) are associated with a greater sense of gregariousness, purpose and well-being, as well as enhanced mental acuity. From an overview of the phenomenon in the NY Times:

As it turns out, testosterone may not be the dread "hormone of aggression" that researchers and the popular imagination have long had it. It may not be the substance that drives men to behave with quintessential guyness, to posture, push, yelp, belch, punch and play air-guitar. If anything, this most freighted of hormones may be a source of very different sensations: calmness, happiness and friendliness, for example.
Friendliness???

Reporting here last week at the annual meeting of the Endocrine Society, researchers said that it was a deficiency of testosterone, rather than its excess, that could lead to all the negative behaviors normally associated with the androgen. Studying a group of 54 so-called hypogonadal men, who for a variety of reasons were low in testosterone, Dr. Christina Wang of the University of California at Los Angeles and her colleagues, found that before treatment, the men expressed a surprising suite of negative emotions. They did not feel passive or depressed or timid, as standard ideas of testosterone deficiency might predict. Instead, they described feelings of edginess, anger, irritability. Aggression.

When the men were given testosterone replacement therapy, and were asked to complete questionnaires about their moods several times over the course of two months of treatment, their general sense of well-being improved markedly. Their anger and agitation decreased, their sense of optimism and friendliness heightened.

Of course, the aforementioned study deals with testosterone deficient, hypogonadal men subsequently receiving treatment with bioidentical synthetic testosterone (not other synthetic steroids), and certainly a unique potential exists for aggressive tendencies as a side effect of various forms of synthetic steroid abuse (for one example, there's no doubt that many anabolics dramatically boost libido and confidence that can be categorized as aggressive behavior), but the rock-solid conventional wisdom about violent maniacs hopped up on steroids is cartoonishly overstated, while the potential upside is ignored.

Back to Turner's column:

Focusing solely on the effects of excessive consumption of, or participation in any substance or activity does not provide an accurate or complete picture. For example, vitamin A is essential for vision, cell growth, and a healthy immune system. Consuming too much of the vitamin can increase the risk of fractures, according to a recent study. If one were only made aware of the ill effects of the excessive consumption of vitamin A, one would be lead to believe that it should not be consumed at all.

While a steroid-vitamin A comparison isn't very analogous, as Vitamin A has a largely invisible impact on the body and much less potential or tangible appeal for abuse, the point still stands - that an end of the spectrum of a substance's potential for abuse should not dictate its overall characterization. Unfortunately, this skewed characterization rules the public discussion of steroids.

And given the fact that I've never taken (nor have any immediate plans to take) steroids, why do I care so much about the mischaracterizations of the steroid debate? Turner nicely sums up a large part of my motivation:

Through all of the sanctimony, the melancholic stories, one-sided "expert" witness testimonies, unimpressive statistics, and inconclusive yet suggestive studies, little if anything was done to educate the "public" about what steroids are. Most people I talk to, and apparently most members of Congress have little or no understanding of steroid composition, the various kinds that exist, their effects, or the existence of other compounds used to counteract many of the adverse side effects reported. And based on the lack of other "expert" witnesses in last week's hearing to provide such information, it seems Congress' purported concern for "America's youth" has little substance.
Few can deny the existence of a certain level of risk associated with the consumption of steroids. However, many, if not all actions carry varying levels of risk � like smoking, drinking, running, or skydiving. Most thinking adults are capable of making countless decisions, performing certain actions, all the while evaluating the risk versus reward of each action. Government attempts to regulate personal behavior is anathema to freedom, and gives fodder to black market commerce � which in turn, increases the level of risk involved with such behavior.

The hype around the steroid debate bleeds out of the targeted impact on professional sports or prevention of youth abuse and into public health decisions that ought to be left to mentally able, consenting adults and properly-informed health care practitioners. As an example, when the Justice Department, along with a variety of state and local health authorities overzealously police the prescription of anabolics, at least partially because such grave societal taboos and overstated health risks have been attached to the use of the drugs, the negative impact is at least two-fold:

1. It increases the likelihood that medically needy patients that could benefit from anabolics can't get them, as any off-label use to counteract a wasting condition that's not specified by the ossified bureaucracy of the FDA might jeopardize a practitioner's license and leave them vulnerable to prosecution. A related chilling effect has also caused chronic pain sufferers and their physicians great difficulty in receiving and dispensing opiate prescriptions.

2. Misinformation creates a climate of irrational fear around substances that have the potential for positive human enhancement, providing a practical buffer to the use of new elective medical technology that could offer great benefit in the coming years.

In short, the steroid debate isn't merely about steroids, or cheating in pro sports, or muscle-heads abusing anabolics to win body building contests and impress girls - it's a litmus test for our society's willingness to engage in informed public debate about the complex issues surrounding the enhancement of human health and performance. And unfortunately for those of us that are willing to embrace the coming potential of the biotech revolution - mentally and physically, eagerly yet intelligently - it's a litmus test that our society is failing.

I blame Michael Wilbon.

Posted by Bill at November 16, 2005 10:03 AM | TrackBack (16)

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Comments

Great article. Well done.

Posted by: joshua at November 16, 2005 01:42 PM

While steroid harm is probably overblown, and there is some question as to how much they help, I still don't want them in baseball.

Posted by: rbj at November 16, 2005 03:32 PM

Sure, distinct issue.

But good luck, the days of detectable enhancement are in their twilight.

Posted by: Bill from INDC at November 16, 2005 03:35 PM

Good points. This is another issue, like recreational drugs, where propaganda tends to obscure the real dangers. Some steroids like fina, anadrol and methyltest almost certainly are bad for you, but much more benign steroids like the beta esters and growth hormones get lumped in with them. It's a bit like lumping heroin and cocaine in with alcohol, tobacco and marijuana.

Deliberate ignorance never helps anything.

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Posted by: Movies Point at November 13, 2006 09:45 PM

Posted by: Movies Point at November 13, 2006 10:50 PM

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http://www.exportersinfo.com

Methods of transfer include a product or good being mailed,
hand-delivered or downloaded from an internet site.
It can be sent in the form of a facsimile, email or during
a telephone conversation.

Posted by: exporters at November 14, 2006 01:06 AM

Posted by: freeastrology at November 14, 2006 01:11 AM

Movies

Posted by: Movies at November 14, 2006 07:02 PM

Posted by: Computers at November 14, 2006 07:02 PM

Posted by: Lindsay Lohan at November 16, 2006 05:33 PM

Pop trio Atomic Kitten will reform to play a concert in support of jailed Liverpool football fan Michael Shields...

Posted by: Garrison Mcintire at November 17, 2006 07:47 AM

Posted by: Lindsay Lohan at November 17, 2006 12:26 PM

Alec Baldwin asks for his voice to be removed from an "unfair" documentary about Arnold Schwarzenegger...

Posted by: Tariq Quintanilla at November 22, 2006 08:17 AM

Alec Baldwin asks for his voice to be removed from an "unfair" documentary about Arnold Schwarzenegger...

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